Research progress in extracorporeal shock wave therapy for rotator cuff injury / 中华创伤杂志

Rotator cuff injury often leads to shoulder pain and dysfunction. For the injured rotator cuff tendon without continuous interruption, conservative treatment is often used. However, the shoulder is used frequent in daily life, which makes that the rotator cuff injury generally shows gradual aggravation and eventually progresses to complete tear due to poor blood supply of the rotator cuff tendon tissue and weak repair ability. In order to reverse the pathophysiological changes after rotator cuff injury and promote the repair of injured rotator cuff tendon, a series of conservative treatments for rotator cuff injury have been explored. Extracorporeal shock wave therapy (ESWT) is one of the representative treatments, but its molecular biological mechanism in promoting rotator cuff repair is still unclear. Therefore, the authors review the progress of ESWT for rotator cuff injury from aspects of the molecular biological mechanism and clinical application status, so as to provide a reference for future researches and clinical application of ESWT.

Application of CT-guided microcoil localization in single utility port video-assisted thoracoscopic surgery for small pulmonary nodules (diameter≤15 mm): A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the application value of CT-guided microcoil localization in pulmonary nodule (diameter≤15 mm) surgery. Methods    The clinical data of 175 patients with pulmonary nodules who underwent single utility port video-assisted thoracoscopic surgery at Nanjing Drum Tower Hospital from August 2018 to December 2019 were retrospectively analyzed. According to whether CT-guided coil localization was performed before operation, they were divided into a locating group and a non-locating group. There were 84 patients (34 males, 50 females, aged 57.8±8.8 years) in the locating group and 91 patients (46 males, 45 females, aged 57.6±10.8 years) in the non-locating group. The localization success rate, localization time, incidence of complications, surgical and postoperative conditions were analyzed between the two groups. Results    All 84 patients in the locating group were successfully located, and localization time was 19.0±3.6 minutes. Among them, 19 (22.6%) patients had a small pneumothorax, 4 (4.8%) pulmonary hemorrhage and 2 (2.4%) coil shift; 6 (7.1%) patients had mild pain, 3 (3.6%) moderate pain and 1 (1.2%) severe pain. Sex (P=0.181), age (P=0.673), nodule location (P=0.167), nature of lesion (P=0.244), rate of conversion to thoracotomy (P=0.414), rate of disposable resection of nodules (P=0.251) and postoperative hospital stay (P=0.207) were similar between the two groups. There were significant differences in nodule size (P<0.001), nature of nodule (P<0.001), the shortest distance from nodule to pleura (P<0.001), operation time (P<0.001), lung volume by wedge resection (P=0.031), number of staplers (P<0.001) and total hospitalization costs (P<0.001) between the two groups. Conclusion    CT-guided microcoil localization has the characteristics of high success rate, and is simple, practicable, effective, safe and minimally invasive. Preoperative CT-guided microcoil localization has important clinical application value for small pulmonary nodules, especially those with small size, deep location and less solid components. It can effectively shorten the operation time, reduce surgical trauma and lower hospitalization costs, which is a preoperative localization technique worthy of popularization.

Research progress in spatiotemporal sustained release of growth factors in bone tissue engineering / 中华创伤杂志

The spatiotemporal distribution of growth factors in bone tissue-engineered repair and reconstruction is critical. Growth factors can be used in bone tissue engineering through different encapsulation methods. Different encapsulation methods make growth factors have different release kinetics. At present, the common physical entrapment, easily degradable carrier and simple spatial structure usually result in poor sustained release of growth factors by burst release. The optimization of release methods of growth factors enables their release at different times and spaces in a biomimetric manner, which is conducive to improving the effect of tissue repair and avoiding the adverse effects of excessive factors. Starting from the necessity of spatiotemporal sustained release of growth factors, the authors summarize growth factors can attain spatiotemporal sustained release by being directly immobilized on the surface of the carrier, encapsulated in the carrier, encapsulated in the microparticles and encapsulated in the carrier by the microparticles and review the spatiotemporal sustained release of growth factors in different encapsulation methods, so as to provide a reference for optimizing spatiotemporal release of growth factor in bone tissue engineering.

Effect of diallyl trisulfide on the expression of folate receptor α in human gastric cancer cell lines BGC823 and AGS and the related regulatory mechanism / 肿瘤研究与临床

Objective:To investigate the effect of diallyl trisulfide (DATS) on the expression of folate receptor α (FRα) in human gastric cancer cells and the related regulatory mechanism.Methods:Human gastric cancer cell lines BGC823 and AGS were selected, BGC823 cells were treated with 10, 20, 40, 80 μmol/L DATS for 48 hours, and AGS cells were treated with 5, 10, 20, 40 μmol/L DATS for 48 hours. Cells treated with 6 μmol/L histone deacetylase (HDAC) inhibitor trichostatin A (TSA) were used as positive control for epigenetic study, and cells untreated with DATS were used as negative control. The apoptosis of gastric cancer cells induced by DATS was detected by flow cytometry. After BGC823 and AGS cells were treated by DATS for 48 hours, they were replaced with DATS-free cell culture medium and cultured for different time to detect the changes in FRα protein expression. BGC823 and AGS cells were treated with 6 μmol/L TSA or 40 μmol/L DATS. The protein expression levels of FRα, HDAC1 and HDAC2, and histone H3 lysine 9 acetylation (H3K9ac) and histone H4 lysine 5 acetylation (H4K5ac) were detected by Western blot. BGC823 cells were inoculated into BALB/c nude mice to establish tumor bearing model. The nude mice in DATS group were injected intraperitoneally with 10 mg/kg DATS for 16 days, and then the protein in tumor-bearing tissues was extracted to detect the expression of target protein, while the control group was injected with equal dose of 0.9% NaCl solution.Results:The expressions of FRα protein in BGC823 and AGS cells were up-regulated in a dose-dependent way after gradient concentrations of DATS treatment ( F = 65.68, P < 0.01; F = 26.65, P < 0.01). After changing the cell culture medium without DATS, the expressions of FRα protein in BGC823 and AGS cells gradually decreased and returned to the initial levels ( F = 74.57, P < 0.01; F = 30.92, P < 0.01). With the increase of DATS concentration, the apoptosis rates of BGC823 and AGS cells increased ( F = 32.95, P < 0.01; F = 38.97, P < 0.01). After TSA treatment, FRα protein expressions in BGC823 and AGS cells were up-regulated by 4.5 times ( t = -12.62, P < 0.01) and 3.6 times ( t = -10.00, P < 0.01). After 40 μmol/L and 20 μmol/L DATS treatment, the expression level of FRα protein in BGC823 and AGS cells was up-regulated (both P < 0.01), the expressions of HDAC1 and HDAC2 were inhibited (all P < 0.01), and the levels of H3K9ac and H4K5ac acetylation modification increased (all P < 0.01). The results of tumor-bearing nude mice experiment showed that the volume of transplanted tumor in DATS group was smaller than that in the control group [(214±39) mm 3 vs. (577±98) mm 3], and the difference was statistically significant ( t = 4.86, P < 0.01). Compared with the control group, FRα protein expression in the transplanted tumor tissues of DATS group was up-regulated about 2 times ( t = -5.29, P < 0.01), and the expression levels of HDAC1 and HDAC2 proteins were down-regulated ( t = 9.36, P < 0.01; t = 9.88, P < 0.01). Conclusions:DATS up-regulates the expression of FRα protein in human gastric cancer BGC823 and AGS cells in a dose-dependent and reversible manner. The mechanism may be related to the effect of DATS on histone acetylation modification in tumor cells.

Research progress in pathological mechanism of rotator cuff injuries / 中华创伤杂志

The rotator cuff injury is a kind of chronic tendon disease related to overuse injury. The main clinical manifestations of this disease include shoulder pain and dysfunction，which seriously affects people 's life quality and work capability. Although previous studies have shown that inflammation and de- generation of collagen matrix are closely related to the occurrence and development of this disease，the pathogenesis of the disease is still unclear. In this study，the authors review the pathologic mechanisms of rotator cuff injuries from aspects of oxidative stress，inflammation，macrophage and non-coding RNA so as to provide a reference for subsequent research and treatment.

Efficacy of early arthroscopic shoulder treatment of moderate full-thickness tear of the supraspinatus tendon / 中华创伤杂志

Objective:To investigate the clinical effect of early arthroscopic shoulder treatment of moderate full-thickness tear of the supraspinatus tendon.Methods:A retrospective case control study was conducted to analyze the clinical data of 43 patients with moderate full-thickness supraspinatus tendon tear admitted to First Affiliated Hospital of Xi 'an Jiaotong University from January 2018 to June 2020，including 17 males and 26 females，aged from 41 to 68 years［（55.9±8.2）years］. All patients had arthroscopic shoulder supraspinatus tendon suture and acromioplasty，including 22 patients underwent surgery within 1 month after persistent shoulder pain and motion limitation in early group and 21 patients between 1 month and 3 months in late group. The duration of operation and intraoperative blood loss were recorded. The visual analogue scale（VAS），American Shoulder and Elbow Society（ASES）score and Constant-Murley score were assessed before operation and at postoperative 3 weeks，6 weeks，3 months and 6 months. The complications were detected with 6 months after operation. Results:All patients were followed up for 6-7 months［（6.4±0.4）months］. There was no statistical significance in operation duration and intraoperative blood loss between the two groups（ P>0.05）. At 3 weeks，6 weeks，3 months and 6 months after operation，there showed significant decrease of VAS but significant increase of ASES and Constant-Murley scores compared to preoperation（ P<0.05）. At 3 weeks and 6 weeks after operation，the VAS in early group［（4.4±0.9）points，（3.7±0.8）points］was lower than that in late group［（5.5±1.0）points，（4.8±1.1）points］；while the ASES score［（49.1±4.6）points，（56.8±4.1）points］and Constant-Murley score［（54.1±4.8）points，（64.1±4.4）points］in early group were higher than those in late group［ASES score：（45.2±5.4）points，（50.3±5.4）points；Constant-Murley score：（50.5±3.3）points，（58.2±3.9）points］（ P<0.05）. At 3 months and 6 months after operation，the two groups showed no statistical significance in these scores. There were no postoperative complications such as infection or nerve injury in both group within 6 months. Conclusion:For moderate full-thickness tear of the supraspinatus tendon，arthroscopic shoulder surgery performed within 1 month after persistent shoulder pain and motion limitation can achieve better pain relief and faster functional rehabilitation in the short term compared with surgery performed 1-3 months later.

Risk factors of venous thromboembolism following lung cancer resection / 中华胸心血管外科杂志

Objective To identify risk factors for postdischarge venous thromboembolism(VTE) following lung resection.Methods Patients undergoing anatomic resection for lung cancer were identified in our institution from 2005-2015.Patient demographic and clinical characteristics were evaluated for any association with post-discharge VTE.Predictors of post-discharge VTE were identified using multivariable analysis.Results VTE occurred in 1.6％ (117) of the 7 154 patients identified.43.6％ (51) VTE events occurred following hospital discharge.Undergoing pneumonectomy was associated with a threefold increased risk for post-discharge VTE compared with lobectomy(2.03％ vs.0.64％,P ＜ 0.01),as was open resection compared to minimally invasive resection(0.86％ vs.0.53％,P＜0.01).Prolonged operative time(＞75％) was also associated with increased risk for post-discharge VTE compared to shorter operative time.Multivariable analysis identified older age,obesity,pneumonectomy,and prolonged operative time as independent predictors for post-discharge VTE.Conclusion The risk for VTE extends after hospital discharge,few patients are managed with post-discharge prophylaxis.Post-discharge prophylaxis should be considered for those at high risk for VTE,particularly for older patients,those who are obese,and following extended or lengthy resections.

Advance of massive tear of the rotator cuff treated with a deltoid flap / 中华骨科杂志

Massive rotator cuff tears often destroy equilibrium of couples of the shoulder joints,whichlead toshoulder pain and functional incapacitation.At present,there is a great controversy about the best treatment strategy for the massive rotator cuff tear,nevertheless surgery has been proved to have more satisfactory results than non-operative treatment.It has been confirmed by numerous studies that cuff repair could prevent loss of shoulder strength and glenohumeral osteoarthritis.However,it is impossible to suture tendon to bone directly due to retraction of tendon stump,fat infiltration of rotator cuff and prominent tear size in massive rotator cuff tear.Muscular flap transfer procedures have played important roles in the treatment of massive rotator cuff tears.Compared with other tendon transposition procedures,such as latissimus dorsi transfer,the deltoid muscular flap may be an optimal method as it works synergistically with the infraspinatus and supraspinatus muscle,and presses down the humeral head potentially.Cuff repair in open operation with tendon stump re-attachment to the deltoid muscle flap,aims to reconstruct the cuff continuity and cover the humeral head toform a new cuff.The deltoid muscle flap,also acting as a muscle cushion,is expected to reduce impingement between the humeral head and the acromion and get better results of pain relief and improvement of shoulder function.However,it is still controversial about the efficacy of deltoid muscle flap transfer in reconstructing a new balance of couple with better shoulder strength,alleviating glenohumeral arthritis and preventing tendon retears.This article reviews the advances in the treatment of chronic massive rotator cuff tears with deltoid flap transfer.

Predictors of survival after treatment of recurrence after esophagectomy / 中华胸心血管外科杂志

Objective To investigate the prognostic factors of postoperative single metastasis in patients with esophageal cancer after treatment.Methods The clinical data of patients with single lesion metastasis from 2002 to 2016 were analyzed retrospectively.Demographic and clinicopathologic data were reviewed.Predictors of PRS after definitive therapy for isolated EC recurrence were determined by the multivariable Cox proportional hazards model.Results Of the 1 016 curative esophagectomies,383 patients(37.7％) experienced recurrences(median followup 53 months).114 (11.2％) received definitive treatment of isolated EC recurrence(63 were treated surgically with or without chemotherapy-radiotherapy[CTRT] and 51 received definitive CTRT alone).Median time to recurrence(TTR) was 18 months.The 1-year and 3-year PRSs were 78.9％ and 38.6％ (median survival 28 months).On multivariable analysis;TTR was the only significant independent predictor for survival after recurrence (HR =0.982,95 ％ CI:0.95-1.03,P =0.036).No pronounced difference was found in disease-free survival or in PRS between recurrent patients treated with operation with or without CTRT and patients who received definitive CTRT.Conclusion A select subgroup of patients with isolated EC recurrence can be treated with curative intent.TTR was the best predictor for PRS.

Advance in acute lung injury after thoracic surgery / 中华胸心血管外科杂志

Acute lung injury after thoracic surgery is the main cause of perioperative death.Acute lung injury is a complex pathophysiological process involving inflammation,characterized by non cardiogenic hypoxemia and acute exudation of the lungs in imaging.Intraoperative ventilation strategy is the most important factor of postoperative acute lung injury.The core of treatment for postoperative acute lung injury is symptomatic support,and prevention is still the most effective strategy for the management of acute lung injury.In this review,the diagnosis,pathogenesis,risk factors and treatment of post-thoracic acute lung injury are introduced,and the progress of prevention strategy and treatment are discussed and summarized.

The prognostic value of peripheral circulating tumor cells in non-small cell lung cancer / 实用医学杂志

Objective To investigate the value of circulating tumor cell(CTC)in non-small cell lung can-cer(NSCLC)and its relationship with clinicopathological features and prognosis. Methods This study totally in-cluded 59 patients with histologically confirmed diagnosis of NSCLC. CTCs were quantified in 7.5 mL peripheral blood samples collected prior to surgery using CellSearch system(Veridex). Statistical analysis of the relationship between CTC positive rate and clinical data,pathological characteristics and prognosis were performed. Results The CTC positive rate was 30.51% and it was significantly correlated with distant metastasis(P = 0.012),TNM stage(P = 0.002)and lymph node metastasis(P = 0.002). The 5-year overall survival rate in the CTCs positive group was significantly lower(22.22% vs. 68.29%,P = 0.005)and the cumulative recurrence was significantly higher(55.55% vs.29.27%,P=0.022)compared with the CTCs negative group.The univariate analysis indicated that the prognostic influencing factors included TNM stage,lymph node metastasis,distant metastasis and CTCs re-sults and the multivariate analysis showed that TNM stage,distant metastasis and CTCs positive were significantly correlated with overall survival and cumulative recurrence(P<0.05). Conclusion CTC is an independent prog-nostic indicator for NSCLC.

ITF increases the transcriptional activity of ITF promoter via the JAK-STAT3 signal transduction pathway / 中南大学学报(医学版)

Objective: To investigate the effect ofintestinal trefoil factor (ITF) on the transcriptional activity of ITF promoter and to explore the regulatory mechanismofJanus kinase/signal transducersand activators of transcription(JAK/STAT) on ITF promoter. Methods: The 5' flanking sequence of the ITF gene was cloned from human whole blood genomic DNA by PCR. ITF promoter fragment was cloned and inserted into the pGL3-Basic vector to construct recombinant vector. ITF promoter vector was stimulated with ITF at various concentrations and the luciferase activity was measured. The JAK-STAT3 signal transductionpathway was then blocked by a speciifc inhibitor AG490 to determine the signal pathway involved in ITF promoter activity. Results: Restriction endonuclease analysis and DNA sequencing confirmed that the recombinant plasmid, containing ITF promoter, was constructed successfully. After transient transfection, the activity of ITF promoter was increased signiifcantly in the presence of ITF (P<0.05). Blockage of the JAK-STAT3 signal transduction pathway with AG490 signiifcantly reduced the ITF promoter activity (P<0.05). Conclusion: ITF increases the transcriptional activity of ITF promoter via the JAK-STAT3 signal transduction pathway.

A study on attention deficit hyperactivity disorder symptoms of children aged 3 to 10 years old and its relationship with sleep / 中华行为医学与脑科学杂志

Objective To investigate the incidence of attention deficit hyperactivity disorder (ADHD)symptoms among 3-10-year-old children and its relationship with sleep.Methods Taking gender,grade (junior in kindergarten to third grade),and region(urban and rural areas) as stratification variable,1 535 children aged 3 to 10 years old were selected by random in six areas nationwide.ADHD Rating Scale-Ⅳ-Parent Version and Pittsburgh Sleep Quality Index were adopted to investigate ADHD symptoms and sleep of these children.Results 24.95％ of the investigated children had ADHD symptoms.Boys scored higher than girls in all indicators(boys:Inattention (IA):(9.21±3.75),Hyperactivity-Impulsivity (HI):(8.62± 3.87),Total:(17.82±7.01),girls:IA:(8.16±3.77),HI:(7.32±3.76),Total:(15.48±6.98)) while girls had higher incidence of ADHD symptoms than boys (girls:IA:16.19％,HI:27.02％,Total:32.51％,boys:IA:11.70％,HI:8.19％,Total:17.43％).Peak incidence occured in children aged 7-9 (7 years old group:IA:18.22％,HI:21.93 ％,Total:38.66％,8 years old group:IA:20.66％,HI:23.25 ％,Total:38.01％,9 years old group:IA:18.22％,HI:33.78％,Total:32.00％).Rural children had higher incidence of ADHD symptoms than urban children(rural children:IA:18.37％,HI:18.37％,Total:29.48％,urban children:IA:10.47％,HI:15.12％,Total:21.40％).Logistic regression results showed that sleep quality,sleep disorder and daily dysfunction can predict the incidence of ADHD symptoms to a certain degree.Conclusion The incidence of ADHD symptoms appear to be high in children evaluating by ADHD Rating Scale-Ⅳ-Parent Version.More attention should be paid to girls and rural children' s ADHD symptoms.7-9 years old children have the highest incidence of ADHD symptoms.The more problems in daytime dysfunction,sleep disorders and bedtime,the more ADHD symptoms will be observed.

Culture of rabbit’s articular chondrocytes using type Ⅱ collagenase enzyme digestion method / 中国组织工程研究

BACKGROUND:At present, the separation and culture technique of chondrocytes has been mature, but the chondrocytes grow slowly which are prone to degenerate using the present technique. It is not conducive to the fol ow-up test. OBJECTIVE:To investigate and improve the separation and culture method of articular chondrocytes of New Zealand rats at 4 weeks of age. METHODS:New Zealand rats aged 4 weeks were selected to take cartilage tissues from the bilateral knees that were resected under aseptic condition. Chondrocytes were isolated by type Ⅱ col agenase enzyme digestion and mechanical isolation method. The cells were cultured and passaged, and then identified by morphologic observation, toluidine blue staining and type Ⅱ col agen enzyme immunohistochemical methods. Growth curve was pictured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide method. RESULTS AND CONCLUSION:Inverted microscope observation showed that the primary cultured chondrocytes adhered at 6 hours after cultivation. The monolayer formation occurred at 72 hours after cultivation, and the cells were ready to be passaged at 96 hours after cultivation. In the fourth generation, some cells represented a spindle-like appearance. In the fifth generation, most cells turned into irregular shape appearance, and cellproliferation capacity diminished. Toluidine blue staining showed that the nuclei of cultured chondrocytes were blue and cytoplasm was pale blue. Immunofluorescent staining showed that cultured chondrocytes had a positive expression of col agen type Ⅱ and the color was tawny. Proliferative rate of chondrocytes in the first to third generations had no differences (P<0.05), while differences were found compared with the fourth generation in 4-7 days (P<0.05) and the fifth generation in 1-7 days (P<0.05). The results indicate that type Ⅱ col agenase enzyme digestion and mechanical isolation method is successful for isolating, cultivating New Zealand rat articular chondrocytes in vitro, and the first to third generations can be the best choice for the experiments of knee osteoarthritis.

In situ hybridization of tight junction molecule occludin mRNA in gastric cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the distribution and significance of occludin mRNA expression in human gastric cancer, as well as its relationship with gastric cancer pathology and multidrug resistance (MDR) in vivo.</p><p><b>METHODS</b>In situ hybridization (ISH) technique was used to evaluate the expression of occludin mRNA in 42 gastric carcinoma specimens obtained by surgery and 23 relatively normal gastric mucosa obtained by gastric endoscopy. All specimens had been stored in cryostatic section.</p><p><b>RESULTS</b>Occludin mRNA was found positive in the cytoplasm of gastric glandulous epithelia as blue particles with intensive stain in 14 of 42 gastric carcinomas (33.3%), 23 of 42 paracancerous gastric tissues (54.8%), 14 of 23 relatively normal gastric tissues (60.9%), 9 of 16 well differentiated carcinomas (56.3%), 4 of 14 moderately differentiated carcinomas (28.6%), 1 of 10 poorly differentiated carcinomas (10.0%) and none of 2 mucosal carcinomas. There were significant differences in occludin mRNA positive rate between relatively normal gastric tissue and gastric cancer as well as between paracancerous gastric tissue and gastric cancer. The expression of occludin mRNA in moderately and poorly differentiated groups was gradually reduced when compared with well differentiated group, which suggests that there be a significant correlation between tumor differentiation and the expression of occludin mRNA. Furthermore, the positive signals of occludin mRNA distributed extensively in the cytoplasm of SGC7901/VCR cell, being vincristine resistant, derived from parental gastric cell line SGC7901. The positive signals of SGC7901/VCR were stronger than those of SGC7901 cells.</p><p><b>CONCLUSION</b>Occludin mRNA, being mainly located in epithelial cells and its expression correlated with tumor differentiation, may be involved in the development of multi-drug resistance in gastric cancer.</p>

Screening of anti-idiotypic antibody to monoclonal antibody MC3 directed against colorectal carcinoma by phage antibody library technology / 中国免疫学杂志

Objective:To generate phage displayed anti idiotypic antibody single chain variable fragments(anti Id ScFv)to monoclonal antibody MC3 directed against colorectal carcinoma.Methods:Balb/c mice were immunized i.p. with MC3(McAb against colorectal Carcinoma) conjugated with KLH,and mRNA was isolated from the spleens of the immunized mice.VH and VL DNAs of the antibody were amplified separately and assembled into ScFv DNAs with a linker DNA by PCR.The ScFv DNAs were ligated into the phagemid vector pCANTAB5E and the ligated sample was transformed into competent E.coli TG1.The transformed cells were infected with M13KO7 helper phage to yield phage antibody ScFv library.After four rounds of panning to the library with MC3,the MC3 positive clones were selected by ELISA from the preselected phages.Results:The VH,VL and ScFv DNAs were about 340,320 and 750 bp respectively.After four rounds of panning to the antibody library,15 MC3 positive phage clones displayed anti Id ScFv were selected from 50 enriched phage clones.Conclusion:The phage displayed anti Id ScFv to MC3 were successfully selected by phage antibody library technology,which might provide new putative candidate molecules for developing recombinant anti Id vaccine of colorectal carcinoma.